Fanapt (Iloperidone) – Oral

Warning:

The Food and Drug Administration (FDA) assigned a black box warning to Fanapt (Iloperidone). This medication isn't FDA approved for dementia-related psychosis. In older adults over 65 years of age, Fanapt raises the risk of death if taken for dementia-related psychosis.

What Is Fanapt?

Fanapt (iloperidone) is a treatment option for schizophrenia. Fanapt is considered a second-generation, or atypical, antipsychotic. It's thought to work by interfering with the activity of dopamine and serotonin. Dopamine and serotonin are naturally occurring chemicals in the brain.

Fanapt is available as prescription tablets.

Drug Facts

Generic Name: Iloperidone

Brand Name(s): Fanapt

Drug Availability: Prescription

Therapeutic Classification: Second-generation, or atypical, antipsychotic

Available Generically: FDA approved but not yet available

Controlled Substance: No

Administration Route: Oral (by mouth)

Active Ingredient: Iloperidone

Dosage Form(s): Tablet

What Is Fanapt Used For?

Fanapt is used for schizophrenia.

It's unknown exactly how common schizophrenia is, but it's estimated that 0.25% to 0.64% of the U.S. population likely has schizophrenia or similar mental health conditions.

The age of onset for schizophrenia is usually between the teenage years and early 30s—with earlier onset (start) in people assigned male at birth and later onset in people assigned female at birth.

Some symptoms of schizophrenia may include:

  • Abnormal thoughts
  • Decreased expression of emotions
  • Delusions
  • Difficulties with memory, concentration, and decision-making
  • Hallucinations
  • Low motivation
  • Movement impairment
  • Relationship problems

How to Take Fanapt

Take Fanapt by mouth twice daily with or without food.

Storage

When you receive Fanapt from the pharmacy, store the medication at room temperature (about 77 degrees Fahrenheit)—with a short-term safety storage range between 59 degrees to 86 degrees. Fanapt should also be protected from light and moisture.

To be safe, keep your medication in a locked cabinet or closet and out of the reach of children and pets.

If you plan to travel with Fanapt, become familiar with your final destination's regulations, such as by checking with the U.S. embassy or consulate. Make a copy of your Fanapt prescription to take with you. Keep your medication in its original pharmacy container, with your name on the label. Consult with your pharmacist or healthcare provider if you have any questions about traveling with your medicine.

You can also ask your pharmacist or healthcare provider about the best ways to dispose of your medications. The FDA's website is a helpful resource regarding where and how to discard of all unused and expired drugs. You can also find disposal boxes in your area.

How Long Does Fanapt Take to Work?

When you start taking Fanapt, your healthcare provider will need to slowly increase your dosage to prevent side effects. As a result, improvement in your symptoms might be delayed until after you received one to two weeks of treatment with Fanapt. Afterward, Fanapt might require up to two to three months for maximum effectiveness.

Off-Label Uses

Fanapt currently has no off-label uses. "Off-label" means using the medication for a condition it was not FDA approved for but that may help treat it.

What Are the Side Effects of Fanapt?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects with Fanapt may include:

  • Dizziness
  • Drowsiness or sleepiness
  • Dry mouth
  • Fast heart rate
  • Postural (or orthostatic) hypotension (drop in blood pressure that can cause light-headedness and dizziness upon standing from a seated or reclined position)
  • Stuffy nose
  • Tiredness or low energy
  • Weight gain

Severe Side Effects

Get medical help right away if you develop the following serious side effects:

  • Severe allergic reaction: If you have a severe allergic reaction to Fanapt, you may experience itchiness, rash, swelling, and breathing difficulties.
  • Abnormal heart rhythm: Fanapt raises your risk of an abnormal heart rhythm. If you're experiencing an abnormal heart rhythm, symptoms may include feeling dizzy or faint and having a rapid or pounding heartbeat.
  • Abnormal white blood cell (WBC) levels: Fanapt is connected to low amounts of WBCs. WBCs are part of your immune system (the body's defense system). Low WBCs might raise your risk of getting an infection. Be on the lookout for a fever or other signs of infection.
  • Body temperature regulation problems: Fanapt may cause body temperature regulation problems. As a result, you might have a higher risk of overheating and dehydration.
  • Cerebrovascular effects: Fanapt is linked to cerebrovascular effects in older adults over 65 with dementia-related psychosis. Cerebrovascular effects may include stroke or transient ischemic attack (TIA).
  • Cognitive impairment: Fanapt might be linked to some cognitive impairment. In cognitive (mental) impairment, you might experience memory, concentration, and decision-making difficulties. Be careful when driving or handling heavy machinery until you know how Fanapt will affect you.
  • Dysphagia: Fanapt is linked to dysphagia, which is a problem with swallowing. Dysphagia might raise your risk of breathing contents (e.g., food) from your digestive system into your lungs. This is called aspiration pneumonia.
  • Hyperprolactinemia: Fanapt might raise your prolactin hormone levels. High prolactin levels may result in symptoms of enlarged breasts, absence of menstrual periods, or milky discharge from nipples. Some people may also experience problems with erection or orgasm.
  • Low blood pressure: While low blood pressure is a common side effect of Fanapt, it can be excessive and severe. Symptoms of extremely low blood pressure may include feeling dizzy and faint. You may also have a fast heart rate, and experience falls. Experiencing falls may also raise your risk of bone fractures (breaks).
  • Metabolic changes: Fanapt might result in metabolic changes, which include high blood sugar, high cholesterol, and weight gain.
  • Movement impairment: Fanapt might cause some loss in muscle control. Before driving or using heavy machinery, see how Fanapt will affect you.
  • Neuroleptic malignant syndrome (NMS): Fanapt might be linked to a rare but life-threatening condition called NMS. Symptoms of NMS may include fever, rigidity (stiff muscles), abnormal blood pressure, fast heart rate, abnormal heart rhythm, and sweating. Some people might also experience abnormal thinking, mood, or behavior changes.
  • Priapism: There are reports of priapism with Fanapt. Priapism is a painful erection of the penis that lasts for hours.
  • Seizures: Fanapt might raise your risk of seizures.
  • Suicide risk: Mental health conditions—like schizophrenia—which Fanapt is prescribed to treat, is linked to a risk of suicide attempts. Prescriptions are written at the lowest dose possible to stem the risk of overdose, but be aware of abnormal changes in mood or behavior.
  • Tardive dyskinesia (TD): Fanapt might be linked to TD. People with TD may experience abnormal muscle movements of the face. These movements might also happen to other parts of the body.

Call 911 if your symptoms or symptoms of a loved on on Fanapt feel life-threatening.

Long-Term Side Effects

Possible long-term side effects with Fanapt may include:

  • Tardive dyskinesia (TD): TD is a potentially severe side effect of abnormal muscle movement. In some people, TD is irreversible.
  • Osteoporosis: High prolactin levels over time may raise your risk of osteoporosis. Osteoporosis is a medical condition of brittle and weak bones.
  • Bone fractures: Fanapt raises your fall risk, which increases the likelihood of bone fractures (breaks). You're more likely to fall with Fanapt because of its side effects, which include drowsiness, sleepiness, low blood pressure, and movement impairment. Your risk for bone fractures may also be high due to your osteoporosis condition.

Report Side Effects

Fanapt may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Fanapt Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For treatment of schizophrenia:
      • Adults—At first, 1 milligram (mg) two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 12 mg two times a day (24 mg per day).
      • Children—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Fanapt:

Severe allergic reaction: Avoid using Fanapt if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In animal studies, Fanapt was found to have negative effects on the fetus. Taking Fanapt during the third trimester in humans was also linked to reports of extrapyramidal (muscle movement) effects and withdrawal (discontinuation) symptoms in newborns. Be aware of symptoms such as agitation, breathing troubles, feeding problems, tremors, or abnormal muscle tone. Symptom severity will vary per newborn.

Consider enrolling in the National Pregnancy Registry for Atypical Antipsychotics online or by calling 866-961-2388. Also, discuss with your healthcare provider if you plan to become pregnant or are pregnant. Your healthcare provider will help you weigh the benefits and risks of taking Fanapt during pregnancy.

Breastfeeding: In animal studies, Fanapt was present in breast milk. Not enough is known about the effects and safety of Fanapt in human breast milk and nursing babies. Therefore, Fanapt typically is not recommended while breastfeeding. Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will help you weigh the benefits and harms of taking Fanapt while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65 years: Clinical studies haven't included a large enough number of people in this age group to determine whether they respond differently from younger adults. However, in older adults with dementia-related psychosis, Fanapt might increase the likelihood of death.

Children: There is little information about the effectiveness and safety of Fanapt in children.

Liver problems: The liver is usually responsible for clearing out medications from your body. If your liver isn't working as well, medications like Fanapt might build up in the body and cause side effects.

For mild liver impairment, dosage adjustments aren't necessary. But your healthcare provider may change your Fanapt dosage for moderate liver impairment. Fanapt hasn't been studied in people with severe liver impairment. As a result, the medication isn't recommended if you fall into this group.

Missed Dose

If you accidentally forget your Fanapt dose, take it as soon as you remember. If it's already close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways that work for you to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, you might experience a relapse or worsening symptoms. If you miss more than three days of doses, reach out to your healthcare provider. They may need to start you on a lower Fanapt dose and slowly increase the dosage again.

Overdose: What Happens If I Take Too Much Fanapt?

An overdose of Fanapt tends to exaggerate the common side effects of this medication. Some symptoms of a suspected overdose may include:

  • Abnormal heart rhythm
  • Drowsiness or sleepiness
  • Extrapyramidal (abnormal muscle movement) effects
  • Fast heart rate
  • Extremely low blood pressure

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Fanapt?

If you think you or someone else may have overdosed on Fanapt, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Fanapt, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after you take this medicine.

This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Call your doctor right away if you have any symptoms of heart rhythm problems, such as dizziness, feeling faint, or a fast, pounding, or irregular heartbeat.

Check with your doctor right away if you have any of the following symptoms while using this medicine: convulsions (seizures), difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

This medicine may cause tardive dyskinesia (a movement disorder). Check with your doctor right away if you have any of the following symptoms while taking this medicine: lip smacking or puckering, puffing of the cheeks, rapid or worm-like movements of the tongue, uncontrolled chewing movements, or uncontrolled movements of the arms and legs.

This medicine may increase prolactin blood levels if used for a long time. Check with your doctor if you have breast swelling or soreness, unusual breast milk production, absent, missed, or irregular menstrual periods, stopping of menstrual bleeding, loss in sexual ability, desire, drive, or performance, decreased interest in sexual intercourse, or an inability to have or keep an erection.

This medicine may increase the amount of sugar in your blood. Check with your doctor right away if you have increased thirst or increased urination. If you have diabetes, you may notice a change in the results of your urine or blood sugar tests. If you have any questions, check with your doctor.

This medicine may increase your weight. Your doctor may need to check your weight on a regular basis while you are using this medicine.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position suddenly. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

Iloperidone can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke. Also, use extra care not to become too cold while you are taking risperidone. If you become too cold, you may feel drowsy, confused, or clumsy.

Iloperidone may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these side effects, tell your doctor right away.

This medicine may cause drowsiness, trouble with thinking, trouble with controlling body movements, or trouble with your vision, which may lead to falls, fractures, or other injuries. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert, well-coordinated, or able to think or see well.

Avoid drinking alcohol while you are using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Fanapt?

Before taking Fanapt, talk with your healthcare provider if any of the following applies to you:

  • Severe allergic reaction: If you have a severe allergic reaction to Fanapt or any of its ingredients, Fanapt isn't recommended for you.
  • Pregnancy: In newborns, taking Fanapt during the third trimester has been linked to extrapyramidal (abnormal muscle movement) effects or withdrawal (discontinuation) symptoms. These symptoms may include agitation, breathing troubles, feeding problems, tremors, or abnormal muscle tone. Symptom severity will vary per newborn. Consider enrolling in the National Pregnancy Registry for Atypical Antipsychotics online or by calling 866-961-2388. Also, talk with your healthcare provider to discuss the benefits and risks of taking Fanapt during your pregnancy.
  • Breastfeeding: There is no information about the effects and safety of Fanapt in breast milk or nursing babies. As a result, Fanapt isn't recommended while breastfeeding. Talk with your healthcare provider to weigh the benefits and harms of taking Fanapt while nursing.
  • Children: There is limited information about the effects and safety of Fanapt in children.
  • Older adults over 65 years of age: There isn't enough information to assess differences in responses to Fanapt between older and younger adults.
  • Liver problems: Mild liver impairment doesn't require any dosage changes, but your healthcare provider may change your dosage for moderate liver impairment. Since Fanapt hasn't been studied in people with severe liver impairment, it isn't recommended.

What Other Medications Interact With Fanapt?

When taking Fanapt, use caution with medications—like a heart medication called Pacerone or Cordarone (amiodarone)—that have a side effect of abnormal heart rhythms. Also, be careful with blood pressure medications, such as Benicar (olmesartan). Fanapt may cause abnormal heart rhythm and low blood pressure. Therefore, combining Fanapt with other medicines with similar side effects may worsen these side effects.

Caution should also be used with CYP2D6 and CYP3A4 inhibitors. CYP2D6 and CYP3A4 are part of the liver's cytochrome P450 (CYP450) family of proteins. These proteins are responsible for breaking down medications—like Fanapt. Medicines that inhibit CYP2D6 or CYP3A4 prevent these proteins from working as well. Therefore, Fanapt might build up in the body, resulting in more side effects. A typical example of a CYP2D6 inhibitor is Paxil (paroxetine) for depression, and an example of a CYP3A4 inhibitor is the ketoconazole antifungal.

Since Fanapt affects the central nervous system (CNS), be careful with other medications that also affect the CNS, which includes the brain and spinal cord. Alcohol also should be avoided.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Fanapt.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Fanapt (iloperidone) is a second-generation, or atypical, antipsychotic. Other similar antipsychotics may are:

  • Abilify (aripiprazole)
  • Clozaril (clozapine)
  • Geodon (ziprasidone)
  • Invega (paliperidone)
  • Latuda (lurasidone)
  • Rexulti (brexpiprazole)
  • Risperdal (risperidone)
  • Saphris (asenapine)
  • Seroquel (quetiapine)
  • Vraylar (cariprazine)
  • Zyprexa (olanzapine)

Regarding these antipsychotics:

  • Clozapine, olanzapine, and risperidone are best at relieving overall schizophrenia symptoms.
  • Olanzapine, paliperidone, and risperidone are best at relieving positive schizophrenia symptoms, such as hallucinations and delusions.
  • Clozapine and olanzapine—with risperidone to a lesser extent—are best at relieving negative schizophrenia symptoms, such as low motivation and decreased expression of emotions.
  • Clozapine and olanzapine are best at treating depression symptoms.
  • Brexipiprazole, lurasidone, olanzapine, paliperidone, and quetiapine are linked to improved social interactions.
  • Olanzapine was linked to weight gain.
  • Lurasidone, olanzapine, paliperidone, and risperidone were linked to higher prolactin levels.
  • Clozapine, iloperidone, olanzapine, quetiapine, and risperidone are linked to more anticholinergic side effects, such as blurry vision, dry mouth, and urination difficulties.

While all of these are antipsychotics, multiple antipsychotics have been used together for schizophrenia.

Frequently Asked Questions

  • Where is Fanapt available?

    Fanapt is available as a prescription from your healthcare provider. Your local retail pharmacy may carry Fanapt. If they don't have Fanapt in stock, the pharmacy staff may need to order the medication for you.

  • How much does Fanapt cost?

    Fanapt isn't available as a generic yet. Therefore, this medication might be expensive.

    If cost is a concern, consider the following potential helpful resources: NeedyMeds, Simplefill, BenefitsCheckUp, Medicare Rights Center, State Pharmaceutical Assistance Programs (SPAPs), Rx Outreach, or FundFinder.

  • Will I need other antipsychotics in addition to Fanapt?

    The number of antipsychotics varies by person. Some people will have symptom relief with just one medication. Some people may require more than one medication to experience symptom control.

  • How long do I have to take Fanapt?

    Schizophrenia is a lifelong medical condition that doesn't currently have a cure. Therefore, you'll likely take the medications that work for you long term.

How Can I Stay Healthy While Taking Fanapt?

If you're taking Fanapt, chances are schizophrenia has impacted your quality of life. Living with schizophrenia can have its challenges. You may have tried different approaches or treatments. The following are suggestions to support your health:

  • Take schizophrenia-related medications as recommended by your healthcare provider.
  • Consider therapy and psychosocial support to help you with managing symptoms and daily challenges at school and work. These treatments and support may also help develop life-management and social skills. They may also help you manage stress and notice any warning signs of a possible relapse of your schizophrenia symptoms.
  • Share your schizophrenia diagnosis with your loved ones, when you're ready. This is a difficult step. The sooner you let them know, however, they can seek out education and support programs to learn more about schizophrenia and find ways to give you the support you need.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  6. ScienceDirect. CYP3A4.

  7. ScienceDirect. Cytochrome P450.

  8. Food and Drug Administration. Drug development and drug interactions | table of substrates, inhibitors and inducers.

  9. Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. The Lancet. 2019;394(10202):939-951. doi: https://doi.org/10.1016/S0140-6736(19)31135-3

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By Ross Phan, PharmD, BCACP, BCGP, BCPS
Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.